Development Of Secondary Sexual Characteristics Research Articles

PMON226 Primary Ovarian Insufficiency: A Case of a Missed Puberty

Abstract Premature Ovarian Insufficiency (POI) is a loss of ovarian function in women less than 40 years old. We present a case of a female with primary amenorrhea due to autoimmune primary ovarian insufficiency (APOI), in which diagnosis was delayed as she had normal breast and pubic/axillary hair development. A 18-year-old female presented to endocrine clinic for evaluation of primary amenorrhea and hypoplastic uterus and ovaries. During her regular follow ups with her pediatrician it was noted that she had not undergone menarche but since her breast development was normal, further evaluation was not pursued. She had a complicated social history and missed several of her follow up appointments. However, further evaluation was done after she presented with severe pain during intercourse. During her physical exam, it was found she had a vaginal opening of 4 cm with an unpalpable cervix. She did however have pubic/axillary hair and breast development consistent with Tanner stage V. Pelvic MRI showed hypoplastic uterus/ovaries. Her lab work revealed she had a total testosterone of 28ng/dL, prolactin 11.1ng/mL, TSH 1.68iIU/mL, LH 42.2mIU/mL, FSH99.77 mIU/mL, estradiol29.36 pg/ML, AMH 3.1ng/mL. Her karyotype was 46XX. Testing for Fragile×Syndrome and 21 hydroxylase antibodies were negative. Anti-ovarian antibody (AOA) was obtained and found to be positive (1: 160). She was diagnosed with APOI and started on estrogen with a goal to increase to adult doses over 1.5-2 years. Progestins are planned to be introduced once she reaches adult doses of estrogen or develops breakthrough bleeding. Typical presentation of patients with POI is primary amenorrhea and lack of breast development during puberty. However, it is important to remember that there can be a broad spectrum of presenting symptoms with variable breast, uterine, and ovarian development as not all patients have the same degree of estrogen deficiency. This is a case of a patient with POI with hypoplastic uterus and ovaries who had Tanner V breast development. Given this patients ovarian atrophy it is likely that the majority of estrogen production originated from adrenal glands and fat cells, which contributed to the normal development of secondary sexual characteristics delaying her diagnosis. Therefore, identification of abnormal menstrual patterns in adolescence should always raise concern for POI even in the setting of normal breast and pubic/axillary hair development. POI is due to premature deprivation of estrogen with subsequent amenorrhea and compensatory elevations in FSH/LH. Early diagnosis of this condition can prevent potential health complications in such as decreased bone mineral density, psychological complications, and extremely painful intercourse as our patient had. It is important to note that fertility in patients with POI is also unpredictable, however earlier diagnosis/treatment can improve fertility preservation, especially in women with normal AMH levels such as this patient. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Caring for Transgender Youth with Eating Disorders in a Day Treatment Program

Background: The treatment of transgender youth with an eating disorder presents particular considerations due to the unique combination of body dissatisfaction, drive for thinness, malnutrition coupled with the evolving gender identity in the midst of biological and physical changes. At this time, public awareness, societal acknowledgment and legislative initiatives have led to wider acceptance of Lesbian, Gay, Bi-sexual and Transgender rights. However, at the same time, transgender youth are at increased risk for mental health problems, including eating disorders. Objective: To describe two cases of trans adolescents with anorexia nervosa treated in a day treatment program. Methods: In this paper, the two clinical vignettes of transgender adolescent with anorexia nervosa will be discussed. The focused care included specific attention to the initial disclosure of gender identity in a safe space, name and pronoun preferences as well as wardrobe and hair style changes. In addition, treatment focused on the reduction of social anxiety around meal consumption with special attention given to the impact of weight on the development of secondary sex characteristics. Themes of identity, rejection and secrecy were explored. Conclusion: In summary, the treatment of transgender youth with anorexia nervosa is more complex than treatment of cis gender youth. Additional issues, such as hormonal treatments, the development of secondary sexual characteristics as well as social and cultural factors can exacerbate eating disorder symptoms. Treatment should focus on understanding the etiology and the trajectory of the disorder within this lens.

Hypogonadism in adolescent girls: treatment and long-term effects.

Hypogonadism in adolescent females presents as delayed puberty or primary amenorrhea. Constitutional delay of growth and puberty, hypogonadotropic hypogonadism and hypergonadotropic hypogonadism represent the principal differential diagnosis of delayed puberty. Girls with hypogonadism require hormone replacement therapy to initiate and sustain puberty. We aimed to provide a brief review concerning treatment for female adolescents with hypogonadism and further to focus on current data regarding long-term effects of therapy. The published studies and articles of the international literature were used regarding the approach to adolescent girls with hypogonadism. The aim of therapy is the development of secondary sexual characteristics and achievement of target height, body composition and bone mass, to promote psychosexual health and, finally, to maximize the potential for fertility. Hypogonadal females need long-term HRT, so it is of great importance to fully define risks and benefits of therapy. The optimal pubertal induction in women contains both estrogens and progesterone regimens. Different therapeutic options have been described over the years in the literature, but larger randomized trials are required in order to define the ideal approach. The latest acquisitions in the field seem to propose that transdermal 17β-estradiol and micronized progesterone present the most physiological formulations available for this purpose. Further studies and follow up are needed concerning the long-term effects of HRT in adolescents.

Precocious Puberty: A Case Report

Background
 Puberty is a transitional period in children with acceleration of growth and development of secondary sexual characteristics. When this period appears before the age of 8 to 9 years in children, it is called precocious puberty. Depending on the primary source of the hormonal production, precocious puberty may be classified as central (gonadotropin dependent or true) or peripheral (gonadotropin independent or precocious pseudo-puberty).
 Case presentation 
 We herein report a case of precocious puberty in a 7,5-year-old girl who has shown early sign of secondary sexual development. Patients complained pain on her nipple, her breasts began to grow in size, and changes in her body odour, but had no complaints about her pubic hair growth and any vaginal discharge. Laboratory findings shown high level in fertility hormones and level of bone age is equal to 10-year-old girl. Patient then had begun to receive monthly therapy of Leuprolide.
 Conclusion
 Detailed history taking on chronological order of thelarche, pubarche, menarche, and adrenarche, followed by assessment on family history, nutritional history, child developmental history, medication history, and neurological complaints should be done in order to diagnose precocious puberty. Physical examination and other examination of bone age determination, Luteinizing Hormone and Follicle-Stimulating Hormone level, and pelvic ultrasound are essentials in defining the diagnosis and treatment. Leuprolide is indicated for Central Precocious Puberty patient who have advanced bone age at the time of initial evaluation. As a clinician, it is necessary to diagnose precocious puberty as soon as possible to have good prognosis for the patient.

Managing Dermatologic Effects of Gender-Affirming Therapy in Transgender Adolescents.

Transgender adolescents seek gender-affirming medical care to address gender identity and incongruence. Improved understanding of the dermatologic impact of gender-affirming medical care such as pubertal suppression, hormone therapy, and surgeries can enhance patient outcome. Pubertal suppression treats dysphoria associated with development of secondary sex characteristics, including androgen-driven acne. Gender-affirming hormone therapy influences acne and hair development in transgender adolescents. Dermatologists can help manage skin effects associated with chest binding and gender-affirming hormone therapy and surgery. Provision of patient-centered gender-affirming care in dermatologic and multidisciplinary settings is essential to improve skin and overall outcomes of gender-affirming therapy.

The Role of Gender Dysphoria in the Development of an Eating Disorder

The Role of Gender Dysphoria in the Development of an Eating Disorder

Pdf 03. Sexually dimorphic growth and maturity in captive mountain chicken frogs Leptodactylus fallax

ABSTRACT - Sexual dimorphism is commonly encountered in amphibians. Its presence and its ontogeny in a given species has implications for ecology, conservation and captive husbandry. We monitored changes in length and mass of captive mountain chicken frogs Leptodactylus fallax. Initially, sexes were no different in snout-vent length or mass, but by about 17 months after metamorphosis females became significantly larger and heavier than males. Diverging growth trajectories between male and female frogs appeared to coincide with the development of secondary sexual characters in males, indicating sexual maturity, while female frogs did not produce nests until the following breeding season, suggesting later reproductive maturity. The absence of similar dimorphism in other large leptodactylids suggests that its presence in L. fallax may be linked to its unique and energy-intense reproductive strategy, which involves extended maternal provisioning of their young.

Demayo Sandra

Introduction: Usual sex determination and differentiation occurs progressively during the period of embryonic development, involving chromosomal differentiation, gonadal differentiation, and somatic or genital differentiation. Swyer syndrome is a disorder of sex chromosomes and sexual differentiation characterized by 46, XY pure gonadal dysgenesis in a phenotypically female person with primary amenorrhea, and a complete absence of functioning gonadal tissue. Gonadal malignancy occurs in 10-30% of cases, so gonadectomy is indicated at the time of diagnosis. The treatment includes, in addition to the gonadectomy, hormone replacement therapy, and psychological support. Objective: To present a case diagnosed and managed in our institution, in addition to reviewing the recent literature about this rare condition, but with a strong physical, psychological and social impact. Methods: Analysis of clinical history of a patient with Swyer's Syndrome, diagnostic and therapeutic management. Bibliographic review. Presentation of the clinical case: An 18-year-old patient attends our hospital presenting primary amenorrhea. She presents BMI: 22; Tanner stage PH III BD III, gynecological examination with vulva and vagina with normal characteristics. Hormone profile requested: FSH 96.8 mU/ml, LH 32.9 mU/ml, Estradiol <25 pg/ml; Total testosterone 0.15 ng/ml. TV ultrasound shows a hypoplastic uterus of 23x11x29 mm, ovaries are not visualized, and a heterogeneous solid image of 22x23x24 mm in the left adnexal region. 46XY karyotype. In the presence of these results, a diagnosis of Swyer's syndrome is made, so an MRI was requested, which shows a uterus of 14x20x26 mm, ovaries are not visualized, a solid lobulated oval image of 23x33x47 mm poorly vascularized standing out in the left adnexal region and free inguinal canals. It was decided to perform exploratory laparoscopy and gonadectomy. The intraoperative findings were: intrapelvic hypoplastic uterus, uterine tubes without any particularities, enlarged left gonad of approximately 3x4 cm pearly white with a hard elastic consistency, and a fibrous band in the right adnexa. Bilateral adnexectomy was performed, obtaining as a histological result well-differentiated left dysgerminoma SALL4 +, OCT3/4 +, negative Inhibin and CD 117 +, and right streak gonad. Conclusions: In the presence of a person with primary amenorrhea and absence or poor development of secondary sex characteristics, Swyer's syndrome should be suspected, and pertinent studies should be requested to arrive at the diagnosis. It is essential to perform gonadectomy at the time of diagnosis due to the risk of malignant transformation. The importance of a multidisciplinary approach and psychological accompaniment of patients and relatives is highlighted.

A Simple Cortisol Biosensor Based on AuNPs-DNA Aptamer Conjugate

Cortisol plays a key role in maintaining human life, regulating body material metabolism, promoting the development of secondary sexual characteristics and ensuring human normal biological function. We have studied an AuNPs-DNA conjugate aptamer biosensor. 20 nm AuNPs were prepared by seed method, and cortisol aptamer were bonded to the surface of gold nanoparticles by Au-S bond. When DNA aptamer binds to cortisol, the intensity of UV-Vis absorption peak of AuNPs decreases. The biosensor can quantitatively detect cortisol at the nanomolar level. The detection range of the biosensor is 1-1000 nM. In addition, the biosensor does not recognize cortisol related compounds, indicating its high selectivity.

Effect of hypertensive disorders of pregnancy on pubertal development in daughters and sons: a systematic review and meta-analysis.

Hypertensive disorders of pregnancy (HDP) are a major cause of maternal and offspring morbidity and mortality worldwide. Several studies in recent years have focused on the link between HDP and pubertal development in offspring. The goal of this study was to synthesize the published literature on the effect of HDP on pubertal development in offspring by a systematic review and meta-analysis (PROSPERO 2021: CRD42020148736). A systematic literature search of several databases was conducted through December 2021, focusing on studies reporting pubertal development in offspring of women with and without HDP exposure. Primary outcomes of interest included offspring body mass index (BMI), height, waist and hip circumference, fat mass, pubarche, thelarche, and age at menarche. A total of 21 studies were finally included. Significantly higher values of BMI (SMD: 0.16 [0.11, 0.22]; p < 0.01) and waist circumference (SMD: 0.21 [0.14, 0.29]; p < 0.01) were found in offspring exposed to maternal HDP. In addition, a tendency of the early development of secondary sexual characteristics only in daughters was presented in offspring whose mothers were diagnosed with HDP. The findings imply a possible effect of HDP on pubertal development in offspring, especially for their BMI and waist circumference, which highlights the importance of focusing on adolescent developmental abnormalities in offspring exposed to HDP.

Deciphering Sex-Specific Differentiation of Human Fetal Gonads: Insight From Experimental Models

Sex-specific gonadal differentiation is initiated by the expression of SRY in male foetuses. This promotes a signalling pathway directing testicular development, while in female foetuses the absence of SRY and expression of pro-ovarian factors promote ovarian development. Importantly, in addition to the initiation of a sex-specific signalling cascade the opposite pathway is simultaneously inhibited. The somatic cell populations within the gonads dictates this differentiation as well as the development of secondary sex characteristics via secretion of endocrine factors and steroid hormones. Opposing pathways SOX9/FGF9 (testis) and WNT4/RSPO1 (ovary) controls the development and differentiation of the bipotential mouse gonad and even though sex-specific gonadal differentiation is largely considered to be conserved between mice and humans, recent studies have identified several differences. Hence, the signalling pathways promoting early mouse gonad differentiation cannot be directly transferred to human development thus highlighting the importance of also examining this signalling in human fetal gonads. This review focus on the current understanding of regulatory mechanisms governing human gonadal sex differentiation by combining knowledge of these processes from studies in mice, information from patients with differences of sex development and insight from manipulation of selected signalling pathways in ex vivo culture models of human fetal gonads.

Medroxyprogesterone acetate in reindeer bulls: testes histology, cfos activity in the brain, breeding success, and semen quality.

A previous study reported that a 400-mg dose of medroxyprogesterone acetate (MPA) reduced male reindeer aggression and blocked development of secondary sexual characteristics but did not completely impair fertility. Here we have repeated that protocol in two separate trials. In 2017, tissues and blood samples, collected from MPA and control (CTL) reindeer bulls, euthanized at 30 and 60 d post-treatment were used to evaluate testes histology and morphometrics, cfos activity in the brain and androgen levels. While testes weight tended to decline from August to September in both groups, indices of spermatogenesis remained high. By September, indices of spermatogenesis were declining in both groups with sperm density lower (P = 0.05) in MPA compared to CTL bulls. Aug CTL bulls had the highest concentrations of androstenedione (A4) (P = 0.009) and testosterone (T) (P = 0.08), whereas these androgens were baseline in Aug MPA bulls. By September, A4 and T levels in CTL bulls declined to levels measured in MPA bulls. Cfos activity had a greater number (P = 0.02) of cfos positive neurons in the central amygdala in MPA compared to CTL bulls, suggesting a heightened fear response among the MPA bulls. In the second trial (2019), MPA-treated bulls, with (E, n = 4) and without (IE, n = 4) breeding experience, were blood sampled at key points from July through September when they were put in individual harems with estrous-synchronized cows. Concentrations of T were greatest (P < 0.001) among E bulls prior to MPA treatment but 1 mo after treatment, both T and A4 were baseline in all eight reindeer. Semen collected by electroejaculation at 60 d post-MPA treatment revealed only minor differences in sperm abnormalities between E and IE bulls using both fresh and frozen/thawed semen. Only three bulls (2 E and 1 IE) sired offspring. Breeding success was not related to previous breeding experience, body weight, or bull age. The failure of some MPA bulls to breed appears to be a behavioral, not a physiological, limitation. Limited application of MPA is clearly a useful tool for managing rut-aggression in non-breeding reindeer. However, the possibility that semen could be collected from MPA-treated bulls using restraint and mild sedation rather than general anesthesia should be investigated. This could improve the quality of semen collection while enhancing the safety of both handlers and animals.

049 Menstrual cycle and endocrine changes during puberty

Puberty leads to the development of secondary sexual characteristics and reproductive ability. The development of the menstrual cycle is a slow gradual process.

017 Introduction in gender dysphoria and cycle suppression

Gender dysphoria refers to the distress experienced by people with an incongruence between their sex assigned at birth and their gender identity. People assigned female at birth with a male gender identity are referred to as trans(gender) men, whereas people assigned female at birth with a female gender identity are referred to as cis(gender) female. Many trans men seek medical treatment to avoid further feminization and induce masculinization, and hereby align their physical characteristics with the identified gender. The preferred treatment protocol depends on the person’s age at time of diagnosis with gender dysphoria. For adolescents (<18 years), treatment can be initiated when a person reaches puberty (Tanner stage 2 or higher, determined by the development of secondary sex characteristics), and aims to suppress pubertal development by administration of gonadotropin-releasing hormone agonist (GnRHa) which reversibly inhibit the production of sex hormones.

Masculinization of Adult Gambusia holbrooki: A Case of Recapitulation of Protogyny in a Gonochorist?

Simple SummaryAlthough gonochoristic fish express one sex or the other in adulthood, some adults display traits similar to those of their opposite sex, suggesting plasticity similar to hermaphrodites. To fully test this potential in the eastern mosquitofish, a gonochorist, two adult stages of females were fed 17α-Methyltestosterone incorporated feed (0–200 mg/kg diet) for 50 days. The hormone (particularly at 50 mg/kg diet) stimulated the formation of complex male copulatory structures and testicular tissue as well as upregulated expression of Anti-Müllerian Hormone gene and altered the behavior from females to males. Collectively, we infer that Gambusia holbrooki retains potential for sex reversal at adulthood, similar to what occurs naturally in hermaphroditic fish and can provide an ideal system to investigate these mechanisms in a regulated fashion.17α-Methyltestosterone (MT) is a synthetic steroid that has been widely used to masculinize many fish species when administered early during larval development, however, reports on its efficacy on adults is limited. To this end, this study investigated the efficacy of MT in the masculinization of the eastern mosquitofish (G. holbrooki) at two adult stages (maiden and repeat gravid females). The treated females were fed control or respective MT incorporated feed (0–200 mg/kg diet) for 50 days. Effects of the hormone on secondary sexual characteristics, internal gonad morphology, expression of the Anti-Müllerian Hormone (amh) gene and sexual behavior of the treated females were investigated. The results showed that MT at the dose of 50 mg/kg feed stimulated secondary sexual character development, upregulated expression of amh, formation of testicular tissue and a shift in the behavior similar to those of normal males, prominently so in treated maiden gravid females. Post-treatment, long-term observations indicated that only two masculinized females reverted back to being females and gave birth to young. Induction of masculinizing effects in most individuals suggests that the sexual phenotype of this species appears to be highly plastic with potential to sex reverse at adulthood. This in combination with its small size and short reproductive cycle could provide an ideal system to explore the mechanisms of sequential hermaphroditism in fish and contribute to genetic control of this pest fish.

Puberty induction with recombinant gonadotropin: What impact on future fertility?

Congenital hypogonadotropic hypogonadism (CHH) is a group of rare diseases characterized by inadequate secretion of the gonadotropins LH (luteinizing hormone) and FSH (follicle stimulating hormone) during the physiological activation periods of the gonadotropic axis. The disease? (anomaly) is present from fetal life and usually persists throughout life. Clinically, hypogonadotropic hypogonadism is associated with neonatal clinical signs (micropenis, cryptorchidism in boys in about half of the cases). The diagnosis is sometimes only evoked in the presence of an absence or arrest of pubertal maturation in the adolescent, which is often poorly tolerated physically and psychologically. Different therapeutic options for pubertal induction have been described, but we lack the necessary larger randomized trials to define the best approaches for both sexes. Historically, congenital hypogonadotropic hypogonadism diagnosed at puberty is treated with testosterone injections. These injections allow the development of secondary sexual characteristics, without an increase in testicular volume in severe forms (FSH deficiency), and a pubertal statural peak. During the last twenty years, studies have underlined the beneficial role of recombinant gonadotropins to induce puberty in this population for future fertility. This is what we will develop.

Oral Versus Transdermal Estrogen for Uterine Maturation in Girls with Turner Syndrome

Background: Turner syndrome (TS) is a genetic disorder caused by the absence of a part or whole X-chromosome with an estimated prevalence of 25-50/100,000 females. The predominant gynecologic manifestation of TS is primary ovarian insufficiency (POI) and inadequate development of secondary sexual characteristics and uterine size. Although uterine growth to allow for future spontaneous pregnancy or embryo transfer is an important goal of care for girls with TS, the optimal method of estrogen delivery and dosing for uterine maturation is unknown.

Evaluation of the efficiency of treatment in girls with central precocious puberty/rapidly progressive puberty via ultrasonography

Introduction: Central precocious puberty (CPP) is defined as the development of secondary sexual characteristics in girls before the age of 8 years due to the activation of the hypothalamus-pituitary-gonadal (HPG) axis, and long-acting GnRH analogues (GnRHa) are used in its standard treatment. The gold standard method for evaluating the efficiency of treatment is to demonstrate the suppression of the LH response with the GnRH stimulation test. Pelvic ultrasonography (US) is an easily accessible, safe, free of ionizing radiation and non-invasive imaging method, which is used for the evaluation of internal genital organs, monitoring of sexual development, and excluding ovarian mass. This study aimed to evaluate the effect of GnRHa treatment on internal genital organs and to determine the role of pelvic ultrasonography in treatment follow-up. &#x0D; Material and Method: Between January 2017 and May 2021, 50 girls who were started on GnRHa treatment due to the diagnosis of CPP or rapidly progressing puberty were followed up, and who underwent pelvic US imaging at the beginning of treatment and in the 1st year of treatment were included in the study. The clinical and sonographic findings were compared before and after the treatment.&#x0D; Results: Of the 50 patients in the study, 52% (n=26) were being followed up with CPP, and 48% (n=24) with rapidly progressive puberty. In the first year of GnRHa treatment, while the suppression of the HPG axis was detected in 82% (n=41) of the cases with the GnRHa test, there was no suppression in 18% (n=9). A decrease in ovarian volume was observed in 73.2% (n=30) of 41 patients with suppression of the HPG axis, a decrease in uterine volume in 65.9% (n=27), and a decrease in uterine anterior-posterior size in 61% (n=25). While endometrial thickness could be measured in 64% (n=32) of the cases before treatment, measurable endometrial thickness was detected in only 6% (n=3) of the cases in the 1st year of treatment. &#x0D; Conclusion: We detected in this study that GnRHa treatment in girls with a diagnosis of CPP/rapid puberty caused a significant regression in ovarian and uterus dimensions and endometrial echo selectability. Our results, in line with the literature, support that pelvic ultrasonography is an appropriate modality for monitoring the suppression of the HPG axis during CPP treatment and may reduce the need for repeated GnRH stimulation tests.

18. Continuation of Gonadotropin-Releasing Hormone Analogue Use Among Transgender and Gender-Diverse Adolescents With Access to Low- or no-Cost Gender-Affirming Medical Care

The Endocrine Society Guideline for Transgender Care and the World Professional Association for Transgender Health Standards of Care recommend the use of gonadotropin-releasing hormone analogues (GnRHa) as a treatment option for adolescents with gender dysphoria who have not completed puberty. These medications attenuate sex hormone production and pause development of secondary sex characteristics. The effects of GnRHa are reversible, allowing adolescents time to explore their gender identity before determining if they would benefit from interventions with partially irreversible effects, such as gender-affirming hormones.

Abstract 125: Tropical hypopitutarism – Single centre experience

Background: Etiology of hypopituitarism differs in tropical countries compared to the West and includes pituitary abscess, snake bite, HIV infection, Sheehan syndrome, road traffic accidents, iron overload states etc.Aims and Objectives: The present case series highlights the spectrum of hypopituitarism in tropical countries.Case Details: C1: 23 y/o female presented with loss of consciousness, unrecordable BP and hypoglycemia. H/O spontaneous pre term delivery at home with significant PPH with lactational failure. C2: 21 y/o male came with c/o poor height and weight gain and poor development of secondary sexual characteristics. Examination revealed a large healed scar over foot which developed after snake bite in past. C3: 41 y/o female with h/o recurrent episodes of altered sensorium. H/o PPH, lactational failure, amenorrhea following home delivery. C4: 30 y/o female presented with h/o delivery with PPH, followed by amenorrhea, lactation failure with sparse axillary, pubic hair. MRI pituitary was normal in C1 and showed empty sella for C2, C3 and C4.Conclusion: The etiology and clinical features of hypopituitarism are variable. Awareness and early recognition in these cases is necessary for optimal management of the patient.